van Oort Pouline M, Bos Lieuwe D, Póvoa Pedro, Ramirez Paula, Torres Antoni, Artigas Antonio, Schultz Marcus J, Martin-Loeches Ignacio
Dept of Intensive Care, Amsterdam UMC, Academic Medical Centre, Amsterdam, The Netherlands.
Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
ERJ Open Res. 2019 Mar 25;5(1). doi: 10.1183/23120541.00212-2018. eCollection 2019 Feb.
Diagnosing ventilator-associated pneumonia (VAP) remains challenging. Soluble urokinase plasminogen activator receptor (suPAR) has prognostic value in critically ill patients with systemic infection. We hypothesised that plasma suPAR levels accurately predict development of VAP.
This observational, multicentre, prospective cohort study compared patients at risk for VAP with a control group. Plasma and tracheal aspirate samples were collected. Plasma suPAR levels were measured on the day of diagnosis and 3 days before diagnosis.
The study included 24 VAP patients and 19 control patients. The suPAR concentration measured 3 days before diagnosis was significantly increased in VAP patients matched samples of control patients (area under the receiver operating characteristic curve (AUC) 0.68, 95% CI 0.52-1.00; p=0.04). Similar results were found on the day of diagnosis (AUC 0.77, 95% CI 0.6-0.93; p=0.01). Plasma suPAR was significantly higher in deceased patients (AUC 0.79, 95% CI 0.57-1.00; p<0.001). Combining suPAR with the Clinical Pulmonary Infection Score, C-reactive protein and/or procalcitonin led to a significantly increased discriminative accuracy for predicting VAP and an increased specificity.
suPAR can be used to diagnose VAP with a fair diagnostic accuracy and has a moderate prognostic accuracy to be used in critically ill intensive care unit patients. Its performance improves when added to other clinically available biomarkers (C-reactive protein and procalcitonin) or scoring systems (Clinical Pulmonary Infection Score and Sepsis-related Organ Failure Assessment).
诊断呼吸机相关性肺炎（VAP）仍然具有挑战性。可溶性尿激酶型纤溶酶原激活物受体（suPAR）在患有全身感染的重症患者中具有预后价值。我们假设血浆suPAR水平可准确预测VAP的发生。
这项观察性、多中心、前瞻性队列研究将有VAP风险的患者与对照组进行了比较。收集了血浆和气管吸出物样本。在诊断当天和诊断前3天测量血浆suPAR水平。
该研究纳入了24例VAP患者和19例对照患者。与对照患者的匹配样本相比，VAP患者在诊断前3天测得的suPAR浓度显著升高（受试者工作特征曲线下面积（AUC）为0.68，95%可信区间为0.52-1.00；p=0.04）。在诊断当天也发现了类似结果（AUC为0.77，95%可信区间为0.6-0.93；p=0.01）。死亡患者的血浆suPAR显著更高（AUC为0.79，95%可信区间为0.57-1.00；p<0.001）。将suPAR与临床肺部感染评分、C反应蛋白和/或降钙素原相结合，可显著提高预测VAP的鉴别准确性并提高特异性。
suPAR可用于诊断VAP，诊断准确性尚可，对重症监护病房的重症患者具有中等预后准确性。当与其他临床可用生物标志物（C反应蛋白和降钙素原）或评分系统（临床肺部感染评分和脓毒症相关器官功能衰竭评估）联合使用时，其性能会有所改善。
